5 Things To Consider When Choosing a TRICARE Health Plan
FALLS CHURCH, VA, December 7, 2023 - Are you enrolled in or eligible for a TRICARE Prime or TRICARE Select plan? During TRICARE Open Season, you may be eligible to change plans or enroll in a plan for 2024. It’s important to understand your plan options so you can choose the right coverage for your family. That’s because open season may be your only chance to change your plan for next year, unless you have a Qualifying Life Event.
Here are some things to consider when you research your plan options.
1. Your Eligibility
Before you research plans, you should know which plans your family members are eligible for. Eligibility is based on your sponsor’s status, your relationship to your sponsor, your location, and a few other factors.
The TRICARE Plan Finder makes it easy to learn what your plan options may be. First, you’ll answer a few quick questions about yourself or a family member. Then, the tool will show you a list of plans you may be eligible for.
Reminder: TRICARE Open Season doesn’t apply to active duty service members. Active duty service members must be enrolled in a TRICARE Prime plan. This doesn’t include the US Family Health Plan (USFHP).
2. How You Prefer To Get Care
- You’ll choose or be assigned a primary care manager (PCM), who will manage your care. Your PCM could be at a military hospital or clinic, or they could be a civilian provider.
- You’ll need to get referrals from your PCM for specialty care and any care your PCM can’t provide. However, you can see a specialist without a referral under the point-of-service option. This will result in higher out-of-pocket costs.
- Your provider will file claims for you in most cases.
In some locations, you may be able to enroll in USFHP. This is a TRICARE Prime option available through networks of not-for-profit health care systems in six areas of the United States. USFHP has slightly different rules for getting care:
- You’ll choose a primary care provider from the network of physicians affiliated with the not-for-profit health care systems in your designated USFHP area. This provider will coordinate your care and help you get appointments with specialists.
- You can’t get care at military hospitals and clinics or from TRICARE network providers. You also can’t use Express Scripts. Instead, you’ll have a different pharmacy network.
TRICARE Select is a self-managed care option, which may give you more flexibility in which providers you can see. With TRICARE Select plans:
- There isn’t a required primary care manager.
- Referrals and pre-authorizations aren’t required in most situations.
- You can get care from any TRICARE-authorized provider.
- You may only get care at military hospitals or clinics if space is available. However, you can use military hospitals and clinics if you need emergency care.
- You can also use military pharmacies.
3. Types of Care You May Need
Your health care needs play a role in how you get care and what your costs will be. Think about the types of care you and your family might need next year and how often you may need to get care.
4. Types of Providers Near You
Do you prefer to get care outside of a military hospital or clinic? Depending on your health plan and the type of care you need, you may have the option to visit any TRICARE-authorized provider. This can be either a network or non-network provider. But choosing a network provider may minimize your out-of-pocket costs, as outlined in the TRICARE Choices in the United States Handbook. Use the Find a Doctor tool to find TRICARE-authorized providers near you.
5. Out-of-Pocket Costs
When you follow your plan’s rules, TRICARE Prime generally has lower out-of-pocket costs than TRICARE Select. But keep in mind that TRICARE Select may offer you more flexibility in how you get care.
Check out the 2024 TRICARE health plan costs to compare plan costs and estimate your health care costs for next year. You may also want to preview your 2024 pharmacy costs.
Remember, TRICARE Open Season ends Tuesday, Dec. 12. Go to TRICARE Open Season to learn more about your eligibility to participate in open season, your plan options, and how to enroll in a plan.